Two exciting new research papers show how Type II diabetes can be prevented and treated. They show two mechanisms by which a drug used to treat diabetes, metformin, lowers blood sugar levels. First I will give you a brief explanation of this research and then I will show how you can use this information to change your lifestyle to help prevent diabetes, or help to treat it if you already have this horrible disease.

Researchers at McMaster University have just shown how the drug metformin (Glucophage) removes fat from the liver (Nature Medicine, November 2013). Most cases of diabetes are caused by fat in the liver preventing the liver from doing its job of removing sugar from the bloodstream. A healthy liver prevents high blood sugar levels by removing sugar from the bloodstream into its liver cells every time blood sugar levels rise too high. If fat accumulates in the liver cells, it can prevent liver cells from responding to insulin and removing sugar from the bloodstream. Metformin lowers high blood sugar levels by removing fat from liver cells. This makes liver cells once again responsive to insulin, so the liver cells can do their job of removing sugar from the bloodstream.

Six months ago, researchers at the University of Pennsylvania showed that metformin lowers production of the hormone glucagon (Nature, published online Jan. 6, 2013). Glucagon causes liver cells to release sugar into the bloodstream, so metformin helps to lower blood sugar levels by blocking glucagon. When blood sugar levels are already high, metformin helps to prevent the liver from releasing sugar from its cells to raise blood sugar levels even higher.

How High Blood Sugar Levels Can Damage Every Cell in Your Body
Cell damage in diabetes is caused by a high blood sugar level causing sugar to stick to the outer surface membranes of cells and destroying cells. If you can prevent blood sugar levels from rising too high, you can prevent sugar from sticking to cells and thus prevent all the horrible side effects of diabetes. For example, sugar stuck on:

Your liver is regulated by insulin that is released from your pancreas.
* When blood sugar levels rise too high, your pancreas releases insulin into the bloodstream. Insulin specifically lowers blood sugar levels by driving sugar from the bloodstream into all cells in your body. Most of the sugar goes into your liver cells.
* When blood sugar levels drop, your pancreas releases glucagon into your bloodstream. Glucagon raises blood sugar levels by driving stored sugar (glycogen) from liver cells into the bloodstream.

How Fat in Your Liver Causes Diabetes
Before insulin can drive sugar from the bloodstream into your liver cells, insulin must first attach to special hooks on cells called insulin receptors. Fat inside cells prevents insulin from attaching to insulin receptor hooks and therefore prevents insulin from lowering high blood sugar levels by driving sugar from the blood into cells.

High blood sugar levels are caused by fat in the liver blocking insulin so the liver cannot remove excess sugar from the bloodstream. Removing fat from the liver allows insulin to do its job of driving sugar from the blood into the liver.

How Can You Tell If You Have Excess Fat in Your Liver?
Your doctor can order a safe and inexpensive sonogram of your liver to see if it is full of fat. Sound waves take a picture of your liver and the radiologist can see the fat inside liver cells.

A simpler way is just to look at yourself in a mirror. Almost all people who store fat primarily in their bellies have a fatty liver and have difficulty responding to insulin. If you have a big belly and small buttocks, you are most likely already diabetic or are on your way to becoming diabetic. When your protruding belly disappears, you are probably cured of your diabetes.

Once you remove fat from your liver cells, your liver usually regains its ability to respond to insulin to remove sugar from the bloodstream. This prevents blood sugar levels from rising too high and you no longer have active diabetes.

About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities.
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